Movember spotlight on healthcare challenges for Gypsy, Roma and Traveller communities

Gypsy, Roma and Traveller communities are known to experience stark health inequalities. Each community within the Gypsy, Roma and Traveller umbrella faces specific difficulties, but there are common threads.

Life expectancy for Gypsies, Roma and Travellers is 10-25 years less than the general UK population. The average health of a Romany or Traveller person in their 60s is comparable to an average White person in their 80s.

Access to healthcare

In March this year, Friends, Families and Travellers approached 100 GPs as a mystery shopping exercise. The mystery shopper said that they were Romany, that they were travelling and that they had no fixed address. Of the 100 surgeries approached, 74 GP surgeries did not follow NHS England guidance and refused to register the mystery shopper because they were unable to provide proof of identity, proof of fixed address, register online or another reason.

A National Pharmacy Association survey showed that men are much more reluctant to access primary care services than women. Many people within Gypsy, Roma and Traveller communities are also more reluctant to access primary care services, in part due to past experience of being poorly treated by healthcare providers, as well as fear of discrimination and poor treatment.

Anecdotal evidence has also shown that some people within Gypsy and Traveller communities are more likely to have a strong, stoic approach and may only access healthcare when a problem has significantly impacted on their life.

The Missing Voices project prepared a report about the needs of disabled people in Gypsy, Roma and Traveller communities in November 2020. Despite some Disabled and Deaf People’s Organisations’ (DDPOs) interest in outreach to local communities, there were low levels of cultural knowledge and contact.

This shows that an ‘our doors are open to all / we do not discriminate’ type of approach is not sufficient to ensure services are available and utilized and a more proactive strategy is needed, particularly amongst Gypsy, Roma and Traveller men who were much less likely to engage with services.

Difficulties accessing primary care can have devastating impact.

Bowel cancer screening plays a vital role in successful treatment of cancer. Studies have shown that Gypsies, Roma and Traveller men are less likely to engage with bowel screening. Significant inequalities in access to bowel screening exist for people who live a nomadic way of life. In a 2019 study of over 350 Liveaboard Boaters, only 53% of people reported having received an invitation for bowel cancer screening when they should have.

In our experience with cases of delayed diagnosis in bowel cancer, earlier intervention improves outcomes, including avoiding a permanent stoma bag, less intensive chemotherapy and increased chance of a cure.

Mental Health

Gypsies and Travellers are twice as likely to be depressed as other communities, and three times more likely to suffer with anxiety. This is particularly stark amongst men – the suicide rate for Traveller men is seven times higher than men in the general population.

In March 2019, Friends Families and Travellers set out some of the key issues surrounding Gypsy, Roma and Traveller mental health in their submissions to a government consultation on the mental health of men and boys:

• Chronic exclusion across the social determinants of health
• High levels of stigma and gendered expectations make it difficult for Gypsy and Traveller men to speak about mental health and therefore to seek help.
• Young Gypsies and Travellers often miss out on chances to learn about mental health or sources of support when experiencing poor mental health.
• Groups within Gypsy, Roma and Traveller communities such as LGBTQ men and boys, or men and boys who have contact with the criminal justice system face double exclusion.
• Many Gypsies and Travellers experience bereavement and untreated trauma from grief.

Without a greater understanding of the challenges facing Gypsy, Roma and Traveller men and boys, and without culturally appropriate interventions, co-created with the communities, Gypsy, Roma and Traveller men will not be able to access healthcare.

What can healthcare professionals and Individuals do?

• Ensure there is awareness of the difficulties faced by Gypsies, Roma and Travellers in accessing healthcare, including intervention for mental health concerns.
• Review your workplace’s policies, and move away from a ‘door open’ approach to Gypsy, Roma, Traveller communities and instead co-produce culturally appropriate services with community members.
• Offer flexibility in communication methods and ensure processes are in place to ensure effective communication.Consider commissioning a targeted service to address specific needs in your area.      

At Leigh Day, we have experience of representing Gypsy, Roma and Traveller people who have suffered injuries due to issues with access to healthcare. If you are concerned that you or someone you know has been injured as a result of medical negligence, you can get in touch. We will listen to you and can offer our support and expert experience.

For more information on practical steps you can take to make your service more inclusive to Gypsy, Roma and Traveller people, view Friends, Families and Travellers’ resource ‘How to tackle health inequalities in Gypsy, Roma and Traveller communities: A guide for health and care services’.